title: Positive experience of intraperitoneal chemotherapy followed by intravenous chemotherapy in heavily pretreated patients with suboptimal residual ovarian cancer and primary peritoneal cancer.
abstract: OBJECTIVE
  To assess feasibility and toxicity of intraperitoneal administration of cisplatin and paclitaxel, followed by intravenous chemotherapy in pretreated patients with suboptimal ovarian cancer (residuum >1 cm) or primary peritoneal tumor, and suffering from ascites and/or intestinal obstruction.
  
  
  METHODS
  Fourteen relapsed ovarian cancer patients, 5 of whom were platinum sensitive (platinum-free interval >6 mo), 7 platinum-resistant (platinum-free interval <6 mo), and 2 platinum-refractory, received one cycle of intraperitoneal cisplatin, 100 mg/m2 on day 1, and two cycles of intraperitoneal paclitaxel, 120 mg/m2 on days 8 and 14. Intravenous chemotherapy was administrated 4 weeks following the last intraperitoneal paclitaxel instillation. Blood and peritoneal fluid samples were harvested at 0, 1, 4 and 24 h after ending paclitaxel delivery to guarantee proper tumor exposure and patient safety.
  
  
  RESULTS
  Intraperitoneal cisplatin determined 6 cases of vomiting grade 1-2 (40% of the morbidity). Intraperitoneal paclitaxel was associated with 6 events of grade 1-2 abdominal pain; the only grade 4 toxicity was one case of neutropenia and one of mucositis. Ascites decreased in 11 patients: the median time to first need for paracentesis was 5 months, compared to a median baseline paracentesis of 4 weeks. Three intestinal normalizations were obtained. The median overall survival was 10 months for our cohort of patients. Intraperitoneal paclitaxel clearance was significantly higher in patients with suboptimal tumor and symptomatic disease than in patients with smaller residual masses and without ascites (P = 0.004).
  
  
  CONCLUSIONS
  Intraperitoneal treatment was feasible, and enhanced response to the following intravenous chemotherapy was seen in these patients.
authors.affiliation: Oncologia Medica 1, Istituto Oncologico Veneto/IRCCS, Padua, Italy. ornella.nicoletto@ioveneto.it
authors.forename: Maria Ornella
authors.initials: MO
authors.lastname: Nicoletto
authors.forename: Maurizia
authors.initials: M
authors.lastname: Dalla Palma
authors.forename: Martin E
authors.initials: ME
authors.lastname: Donach
authors.forename: Milena
authors.initials: M
authors.lastname: Gusella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappetta
authors.forename: Malihe
authors.initials: M
authors.lastname: Shams
authors.forename: Aberto
authors.initials: A
authors.lastname: Marchet
authors.forename: Margherita
authors.initials: M
authors.lastname: Nardin
authors.forename: Giovanna
authors.initials: G
authors.lastname: Pintacuda
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Maggio
authors.forename: Maddalena
authors.initials: M
authors.lastname: Marchesi
authors.forename: Paolo
authors.initials: P
authors.lastname: Carli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fiduccia
authors.forename: Grazia
authors.initials: G
authors.lastname: Artioli
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology; D002291:Carcinoma, Papillary / Q000188:drug therapy; D018293:Cystadenoma, Serous / Q000188:drug therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D018365:Neoplasm, Residual / Q000150:complications / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000150:complications / Q000188:drug therapy*; D017671:Platinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017671:Platinum Compounds; D017239:Paclitaxel